Pediatric Informatics: Computer Applications in Child Health (Health ...

308 D.M.N. Paperny
22.4.7 Maintaining Confidentiality in Workflow
An appropriate workflow for confidential (nonpsychiatric) medical visits must alert
staff to the needs for confidentiality of visits:
Use confidential appointment codes to suppress home mailers (results, bills, and
quality of service surveys) and coverage codes (used when the patient is unable
to pay on date of service)
Create two encounters, one for the confidential component of a visit (i.e., a
routine physical and a confidential visit), with one registration fee
Assign a temporary private billing address for the confidential visit (primarily if
the patient is paying out-of-pocket)
Note sensitive diagnoses in the problem list and laboratory test results as
“confidential”
Do not release information for the confidential portion of the visit without
patient consent
Maintain information assurance standards during the visit
A family practice physician seeing a mother and her teenage daughter in the exam room
was charting in the EMR and was called out of the room by the nurse for an urgent call.
He neglected to lock the workstation screen and the mother was able to read the following
diagnosis from her daughter’s record problem list: “CONTRACEPTIVE MANAGEMENT –
“confidential”
A 16 year old girl seen in a hospital emergency department (ED) with gastritis was
surprised to find she was pregnant (on routine ED screening), and she asked the ED physician
not to tell her mother who accompanied her. When the hospital ED bill was sent to the
home 3 weeks later, her father, the hospital custodian, noticed the pregnancy test on the
bill. The next day at work he was able to access the positive result in the unprotected lab
computer system by simply typing in her medical record number.
22.4.8 Using Communications Practices
That Assure Privacy
Appropriate “good practice” communication policies should be made clear for
patients and staff. Appropriate telephone and fax practices include:
Contact patients directly when possible for telephone messages or leave a
message for a call back
Educate patients, families, and staff of inappropriateness of leaving messages
about sensitive issues
Use alternative forms of communication if there is no reply to a message
Document all communications, attempts, and discussions in the patient record
with date/times.
For fax, include sender telephone number for contact in the case of mis-delivery.
Double-check with recipients regarding the secure location of the receiving machine